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Background In humans, Streptococcus agalactiae or group B streptococcus (GBS) is a frequent coloniser of the rectovaginal tract, a major cause of neonatal infectious disease and an emerging cause of disease in non-pregnant adults. In addition, Streptococcus agalactiae causes invasive disease in fish, compromising food security and posing a zoonotic hazard. We studied the molecular epidemiology of S. agalactiae in fish and other aquatic species to assess potential for pathogen transmission between aquatic species and humans. Methods Isolates from fish (n = 26), seals (n = 6), a dolphin and a frog were characterized by pulsed-field gel electrophoresis, multilocus sequence typing and standardized 3-set genotyping, i.e. molecular serotyping and profiling of surface protein genes and mobile genetic elements. Results Four subpopulations of S. agalactiae were identified among aquatic isolates. Sequence type (ST) 283 serotype III-4 and its novel single locus variant ST491 were detected in fish from Southeast Asia and shared a 3-set genotype identical to that of an emerging ST283 clone associated with invasive disease of adult humans in Asia. The human pathogenic strain ST7 serotype Ia was also detected in fish from Asia. ST23 serotype Ia, a subpopulation that is normally associated with human carriage, was found in all grey seals, suggesting that human effluent may contribute to microbial pollution of surface water and exposure of sea mammals to human pathogens. The final subpopulation consisted of non-haemolytic ST260 and ST261 serotype Ib isolates, which belong to a fish-associated clonal complex that has never been reported from humans. Conclusions The apparent association of the four subpopulations of S. agalactiae with specific groups of host species suggests that some strains of aquatic S. agalactiae may present a zoonotic or anthroponotic hazard. Furthermore, it provides a rational framework for exploration of pathogenesis and host-associated genome content of S. agalactiae strains.

HIV-1 control in sub-Saharan Africa requires cost-effective and sustainable programmes that promote behaviour change and reduce cofactor sexually transmitted infections (STIs) at the population and individual levels. We measured the feasibility of community-based peer education, free condom distribution, income-generating projects, and clinic-based STI treatment and counselling services and evaluated their impact on the incidence of HIV-1 measured over a 3-y period in a cluster-randomised controlled trial in eastern Zimbabwe. Analysis of primary outcomes was on an intention-to-treat basis. The income-generating projects proved impossible to implement in the prevailing economic climate. Despite greater programme activity and knowledge in the intervention communities, the incidence rate ratio of HIV-1 was 1.27 (95% confidence interval [CI] 0.92-1.75) compared to the control communities. No evidence was found for reduced incidence of self-reported STI symptoms or high-risk sexual behaviour in the intervention communities. Males who attended programme meetings had lower HIV-1 incidence (incidence rate ratio 0.48, 95% CI 0.24-0.98), and fewer men who attended programme meetings reported unprotected sex with casual partners (odds ratio 0.45, 95% CI 0.28-0.75). More male STI patients in the intervention communities reported cessation of symptoms (odds ratio 2.49, 95% CI 1.21-5.12). Integrated peer education, condom distribution, and syndromic STI management did not reduce population-level HIV-1 incidence in a declining epidemic, despite reducing HIV-1 incidence in the immediate male target group. Our results highlight the need to assess the community-level impact of interventions that are effective amongst targeted population sub-groups.

There are large numbers of vulnerable children in African countries affected by HIV/AIDS. In sub-Saharan Africa about one-third of children are underweight while immunisation coverage, a proxy for access to health services, suggests that around half of children have limited access; the prevalence of child labour is estimated at 30% while some 40% of children do not complete primary school.14 Despite the fact that children affected by HIV/AIDS seem more likely to suffer malnutrition, child labour, and lack of access to basic services, it would be wrong to conclude that provision of special programmes for HIV/AIDS-affected children is the most appropriate programmatic response. Guaranteeing the rights of all children who live in communities affected by AIDS is more beneficial than singling out specific groups, such as so-called \"AIDS orphans\", for support. Systems-based responses are justified by the large numbers of children involved, whose health and wellbeing are affected by poor living conditions and limited access to services. What is needed is a continuum of responses, with-at one end-specific assistance provided to protect the rights of the relatively small number of extremely vulnerable children, including those with severe disabilities, abused children, orphans without supportive extended family care, and abandoned and street children, and-at the other end-better access for all children to health, education, and welfare provision, improving the mean level of health and wellbeing of all young people in society and simultaneously reducing the number of extremely vulnerable children. This public health approach alone will help to translate the vision of children's rights contained in the Convention into reality.15

As a result of the AIDS epidemic, an increasing number of children throughout the world have lost their parents. Africa has been hardest hit by the pandemic, and millions of children have been left orphaned. In this Sounding Board article, Foster, who works in a hospital in Zimbabwe, describes the scope of the problem and argues that external aid agencies must work with local communities to distribute resources effectively to assist children who have been orphaned. Kofi Annan, Secretary-General of the United Nations, has called for wealthy nations to fund a $10 billion annual “war chest” to respond to the AIDS epidemic. Such funding is important, but how these funds are actually spent is even more critical. On the basis of my experience in providing support for orphans and other vulnerable children in Africa, I believe that such resources will do the most good if they are used to strengthen existing community groups whose mission is to support such children. I think the institutional barriers to the distribution of resources to community groups must be surmounted . . .

Introduction Definitions of retention‐in‐care in Prevention of Mother‐to‐Child Transmission of HIV (PMTCT) vary substantially between studies and programmes. Some definitions are based on visits missed/made, others on a minimum total number of visits, or attendance at a final clinic visit at a specific time. An agreed definition could contribute to developing evidence‐based interventions for improving retention‐in‐care. In this paper, we estimated retention‐in‐care rates according to different definitions, and we quantified and visualized the degree of agreement between definitions. Methods We calculated retention in care rates using nine definitions in the six INSPIRE PMTCT intervention studies, conducted in three sub‐Saharan African countries between 2013 and 2017. With data from one of the studies (E4E), we estimated the agreement between definitions using Gwet’s agreement coefficient (AC1) and concordance. We calculated positive predictive values (PPV) and negative predictive values (NPV) for all definitions considering successively each definition as the reference standard. Finally, we used a Multiple Correspondence Analysis (MCA) to examine clustering of the way different definitions handle retention‐in‐care. Results Retention‐in‐care rates among 5107 women ranged from 30% to 76% in the complete dataset with Gwet’s AC1 being 0.56 [0.53; 0.59] indicating a moderate agreement between all definitions together. Two pairs of definitions with high inner concordance and agreement had either very high PPV or very high NPV, and appeared distinct from the other five definitions on the MCA figures. These pairs of definitions were also the ones resulting in the lowest and highest estimates of retention‐in‐care. The simplest definition, that only required a final clinic visit to classify women as retained in care, and classified 55% of women as retained in care, had a PPV ranging from 0.7 to 1 and a NPV ranging from 0.69 to 0.98 when excluding the two pairs afore‐mentioned; it resulted in a moderate to substantial agreement and a 70% to 90% concordance with all other definitions. Conclusions Our study highlights the variability of definitions in estimating retention‐in‐care. Some definitions are very stringent which may be required in some instances. A simple indicator such as attendance at a single time point may be sufficient for programme planning and evaluation.

Definitions of retention?in?care in Prevention of Mother?to?Child Transmission of HIV (PMTCT) vary substantially between studies and programmes. Some definitions are based on visits missed/made, others on a minimum total number of visits, or attendance at a final clinic visit at a specific time. An agreed definition could contribute to developing evidence?based interventions for improving retention?in?care. In this paper, we estimated retention?in?care rates according to different definitions, and we quantified and visualized the degree of agreement between definitions. We calculated retention in care rates using nine definitions in the six INSPIRE PMTCT intervention studies, conducted in three sub?Saharan African countries between 2013 and 2017. With data from one of the studies (E4E), we estimated the agreement between definitions using Gwet?s agreement coefficient (AC1) and concordance. We calculated positive predictive values (PPV) and negative predictive values (NPV) for all definitions considering successively each definition as the reference standard. Finally, we used a Multiple Correspondence Analysis (MCA) to examine clustering of the way different definitions handle retention?in?care. Retention?in?care rates among 5107 women ranged from 30% to 76% in the complete dataset with Gwet?s AC1 being 0.56 [0.53; 0.59] indicating a moderate agreement between all definitions together. Two pairs of definitions with high inner concordance and agreement had either very high PPV or very high NPV, and appeared distinct from the other five definitions on the MCA figures. These pairs of definitions were also the ones resulting in the lowest and highest estimates of retention?in?care. The simplest definition, that only required a final clinic visit to classify women as retained in care, and classified 55% of women as retained in care, had a PPV ranging from 0.7 to 1 and a NPV ranging from 0.69 to 0.98 when excluding the two pairs afore?mentioned; it resulted in a moderate to substantial agreement and a 70% to 90% concordance with all other definitions. Our study highlights the variability of definitions in estimating retention?in?care. Some definitions are very stringent which may be required in some instances. A simple indicator such as attendance at a single time point may be sufficient for programme planning and evaluation.

Like Rich and colleagues, we have found that S schleiferi subspecies coagulans has been recovered from ears and skin in a roughly 4:1 ratio, and it has not been recovered from any other site in dogs to date. sac vs also carries out identification of coagulase-positive Staphylococcus species from a range of animal species, both domestic and wild, including those on the land, in the sea and in the air, but we have never isolated S schleiferi subspecies coagulans from any of these other sources, suggesting that this species is adapted to the canine host.

SIR - We wish to report a case of fungal encephalitis due to Aspergillus fumigatus infection in a juvenile male northern bottlenose whale (Hyperoodon ampullatus) that stranded on the north-east coast of Scotland at North Kessock, Highland, in October 2006.